【摘要】 目的 分析绝经后骨折患者血清骨碱性磷酸酶(BALP)、Ⅰ型前胶原(PCⅠ)和骨形态发生蛋白2水平(BMP-2)及其与骨质疏松程度的相关性。方法 选取2019年2月—2020年2月南宁市第二人民医院收治绝经后骨折患者171例作为研究组，根据骨密度(BMD)分为正常亚组55例、减少亚组67例、疏松亚组49例。另选取同时期在医院体检的绝经未骨折女性177例作为对照组。采用酶联免疫吸附试验(ELISA)检测受试者血清BALP、PCⅠ和BMP-2水平并进行组间比较；采用Spearman法分析血清BALP、PCⅠ和BMP-2水平与骨代谢相关指标的相关性；ROC曲线分析血清BALP、PCⅠ和BMP-2对绝经后骨折的预测价值；多因素Logistic回归分析影响绝经后骨折发生的影响因素。结果 与对照组比较，研究组患者血清BALP、PCⅠ水平升高，BMP-2水平降低(t/P=4.173/<0.001、11.693/<0.001、10.038/<0.001);骨密度正常亚组、减少亚组和疏松亚组患者血清BALP、PCⅠ水平依次升高，BMP-2水平依次降低(F/P=9.943/<0.001、83.323/<0.001、63.602/<0.001)。经Spearman法分析，绝经后骨折患者血清BALP、PCⅠ与骨钙素N端中分子片段(N-MID)、β-联降解产物(β-CTX)、骨钙素(OC)呈正相关(BALP:r/P=0.424/0.001、0.536/<0.001、0.622/<0.001;PCⅠ:r/P=0.503/<0.001、0.510/<0.001、0.497/0.006),血清BMP-2与N-MID、β-CTX、OC呈负相关(r/P=-0.597/<0.001、-0.614/<0.001、-0.544/<0.001)。ROC曲线分析结果表明，血清BALP、PCⅠ、BMP-2及三者联合预测绝经后骨折发生的AUC为0.734、0.901、0.845、0.963,三者联合预测价值较单项指标高(Z=8.046、3.377、5.165,P均<0.001)。多因素Logistic回归分析显示，N-MID高、β-CTX高、OC高、BALP高、PCⅠ高和BMP-2低水平是绝经后骨折发生的危险因素[OR(95%CI)=2.223(1.230～3.987)、1.498(1.114～2.014)、3.401 (1.713～6.754)、3.560(1.616～7.843)、5.222 (1.956～13.941)、3.168(1.986～5.294)]。结论 绝经后骨折患者血清中BALP、PCⅠ水平升高，BMP-2水平降低，并且三者均与骨质疏松程度有关。更多还原

【Abstract】 Objective To analyze the serum levels of bone alkaline phosphatase(BALP), procollagen type I(PCⅠ) and bone morphogenetic protein 2(BMP-2) in postmenopausal fracture patients and their correlation with the degree of osteoporosis.Methods A total of 171 postmenopausal fracture patients admitted to Nanning Second People’s Hospital from February 2019 to February 2020 were selected as the research group. According to bone mineral density(BMD), they were divided into normal subgroup of 55 cases, decreased subgroup of 67 cases, and loose subgroup 49 cases. In addition, 177 postmenopausal women without fractures who underwent physical examination in the hospital during the same period were selected as the control group. Enzyme-linked immunosorbent assay(ELISA) was used to detect the serum BALP, PCⅠ and BMP-2 levels of subjects and compared between groups; Spearman method was used to analyze the correlation between serum BALP, PCⅠ and BMP-2 levels and bone metabolism-related indexes; The predictive value of serum BALP, PCI and BMP-2 in postmenopausal fractures was analyzed by ROC curve; the influencing factors of postmenopausal fractures were analyzed by multivariate Logistic regression analysis.Results Compared with the control group, the serum levels of BALP and PCI in the study group were increased, and the level of BMP-2 was decreased(t/P=4.173/<0.001, 11.693/<0.001, 10.038/<0.001); normal subgroup, decreased subgroup and The serum levels of BALP and PCI in the loose subgroup increased in turn, while the level of BMP-2 decreased in turn(F/P=9.943/<0.001, 83.323/<0.001, 63.602/<0.001). Analysis by Spearman method showed that serum BALP and PCI in postmenopausal fracture patients were positively correlated with osteocalcin N-terminal middle molecular fragment(N-MID), β-linked degradation product(β-CTX), and osteocalcin(OC)(BALP:r/P=0.424/0.001, 0.536/<0.001, 0.622/<0.001; PCI: r/P=0.503/<0.001, 0.510/<0.001, 0.497/0.006), serum BMP-2 and N-MID, β-CTX and OC were negatively correlated(r/P=-0.597/<0.001,-0.614/<0.001,-0.544/<0.001); ROC curve analysis showed that serum BALP, PCI, BMP-2 and their combination predicted menopause The AUC of posterior fractures was 0.734, 0.901, 0.845, and 0.963, and the combined predictive value of the three was higher than that of the individual indicators(Z=8.046, 3.377, 5.165, all P<0.001). High β-CTX, high OC, high BALP, high PCI and low levels of BMP-2 were risk factors for postmenopausal fractures [OR(95%CI)=2.223(1.230-3.987),1.498(1.114-2.014),3.401(1.713-6.754),3.560(1.616-7.843),5.222(1.956-13.941),3.168(1.986-5.294)].Conclusion The serum levels of BALP and PCⅠin postmenopausal fracture patients increased, while the level of BMP-2 decreased, and the three were related to the degree of osteoporosis.更多还原